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At the end of our investigation of an incident or noncompliant activity, we produce an investigation report that summarizes what we found. These investigation reports are archived; we publish more recent investigation reports on our Compliance Dashboard.

The following archived reports discuss

  • our investigation of the incident,
  • our assessment of the root cause,
  • contributing factors, and
  • the sequence of events leading to the incident or noncompliant activity.

The reports are sorted by publication date, from most to least recent.

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